Arthroscopic Osteochondral Autologous Transplantation(OAT)for Treating Femoral Trochlear Cartilage Defects: The Outcomes Of 1 Year To 6 Years Follow-up Study

Purpose: To evaluate the outcome of osteochondral autografts transplantationfor treatment of femoral trochlear cartilage defects with OAT at a shot-term-to medium follow-up.Methods: Between May 2010 and July 2016,20 patients with symptomatic,full thickness cartilage lesions of femoral trochlear between 7mm and 22 mm in diameter were treated with arthroscopic OAT.Autograft cores,7~9mm/diameter x 8-10 mm /depth in size,were harvested from the superio-lateral intercondylar notch and inserted into the sockets drilled into the defect with OATS(Osteochondral Autograf Transfer System).14 patients(70%),a mean age of 39.3years,were available for a follow up.The duration of symptoms was from 3 week to 24 months and the mean follow-up was 36.3 months(range,12 to72 months),all patients were operated on the affected knee for the first time.Patients were evaluated with the mean Lysholm score,International Knee Documentation Committee(IKDC)Standard Evaluation Form,International Cartilage Repair Society(ICRS),magnetic resonance imaging(MRI),second-look arthroscopy.Ten cases had second MRI examination performed 1 year after operation.Two patients had second-look arhtroscopy after 4 months.Result: The mean Lysholm score significantly improved from 49.6 preoperatively to 91.5 postoperatively(P <.001).Excellent or good outcome was accomplished in 12 of the patients(85.7%).Using the IKDS assessment,Thirteen(92.9%)returned to normal live or sports activities at the preinjury level at the an average or an average of 5.8 months(range,3 to 8 months).No serious complications were reported.There was 1 failure because of earlier sports activities after OAT.The ICRS cartilage Repair Assessment for macroscopic evaluation during arthroscopy at 4 months showed excellent repair.Second-look arthroscopy was performed in 2 cases after 4 months.The two patients had complete healing with the recipient position revealed normal hyaline cartilage,and with the donor socket filled with bone and nearly mormal cartilage covered.MRI evaluation from 10/14(71.4%)of the patients showed that the congruency of the articular surface was restored,with excellent or good repairs in 9 of 10 patients(90%).Conclusions: Arthroscopic OAT is an effective and safe method of treating symptomatic full-thickness chondral defects of the femoral trochlea,especially for treatment of small,grade IV cartilage defects in relatively younger patients.However,further studies with long-term follow-up are needed to determine if the recipient area and donor area will maintain normal or nearly normal structure and function.